Skip to main content

Advertisement

SpringerLink
Log in

Persistent part-solid nodules with solid part of 5 mm or smaller: Can the ‘follow-up and surgical resection after interval growth’ policy have a negative effect on patient prognosis?

  • Chest
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To investigate whether “follow-up and surgical resection after interval growth” can negatively influence recurrence or mortality in patients with persistent part-solid nodules (PSNs) with solid components ≤5 mm.

Methods

One hundred twenty five surgically resected persistent PSNs with solid components ≤5 mm in 125 individuals were evaluated. Of the 125 PSNs, 54 and 71 PSNs were categorized into interval growth and immediate surgery groups, respectively. Cox regression analysis was performed to evaluate the association of “follow-up until interval growth” with recurrence and survival, adjusted for initial clinical and CT features.

Results

In the interval growth group, 30 patients showed increased nodule size, 10 increased solid parts, and the remaining 14 both patterns. Five patients showed clinical stage shifts (stage T1a, initially, to T1b after interval growth). Post-operative disease recurrence occurred in six individuals (interval growth group, n = 2/54; immediate surgery group, n = 4/71), and four individuals died (interval growth group, n = 1/54; immediate surgery group, n = 3/71). There were no significant differences between these two groups in terms of recurrence-free survival (p = 0.451) and overall survival (p = 0.185).

Conclusion

“Follow-up and surgical resection after interval growth” did not negatively influence the prognosis of patients with persistent PSNs with solid components ≤5 mm.

Key Points

• Incidences of post-operative recurrence or death in patients with PSN are low.

• “Follow-up until interval growth” of PSNs does not negatively influence disease recurrence.

• There was no survival disadvantage related with “follow-up until interval growth” in PSNs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

GGN:

Ground-glass nodule

PSN:

Part-solid nodule

AIS:

Adenocarcinoma-in-situ

MIA:

Minimally-invasive adenocarcinoma

References

  1. Naidich DP, Bankier AA, MacMahon H et al (2013) Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society. Radiology 266:304–317

    Article  PubMed  Google Scholar 

  2. Kim H, Park CM, Koh JM, Lee SM, Goo JM (2014) Pulmonary subsolid nodules: what radiologists need to know about the imaging features and management strategy. Diagn Interv Radiol 20:47–57

    Article  PubMed  Google Scholar 

  3. Kobayashi Y, Sakao Y, Deshpande GA et al (2014) The association between baseline clinical–radiological characteristics and growth of pulmonary nodules with ground-glass opacity. Lung Cancer 83:61–66

    Article  PubMed  Google Scholar 

  4. Sawada S, Komori E, Nogami N, Segawa Y, Shinkai T, Yamashita M (2009) Evaluation of lesions corresponding to ground-glass opacities that were resected after computed tomography follow-up examination. Lung Cancer 65:176–179

    Article  PubMed  Google Scholar 

  5. Lee HJ, Goo JM, Lee CH, Yoo C-G, Kim YT, Im J-G (2007) Nodular ground-glass opacities on thin-section CT: size change during follow-up and pathological results. Korean J Radiol 8:22–31

    Article  PubMed  PubMed Central  Google Scholar 

  6. Kakinuma R, Ashizawa K, Kuriyama K et al (2012) Measurement of focal ground-glass opacity diameters on CT images: interobserver agreement in regard to identifying increases in the size of ground-glass opacities. Acad Radiol 19:389–394

    Article  PubMed  Google Scholar 

  7. Lee SW, Leem C-S, Kim TJ et al (2013) The long-term course of ground-glass opacities detected on thin-section computed tomography. Respir Med 107:904–910

    Article  PubMed  Google Scholar 

  8. Kobayashi Y, Fukui T, Ito S et al (2013) How long should small lung lesions of ground-glass opacity be followed? J Thorac Oncol 8:309–314

    Article  PubMed  Google Scholar 

  9. Chang B, Hwang JH, Choi Y-H et al (2013) Natural history of pure ground-glass opacity lung nodules detected by low-dose CT Scan. Chest 143:172–178

    Article  PubMed  Google Scholar 

  10. Matsuguma H, Mori K, Nakahara R et al (2013) Characteristics of subsolid pulmonary nodules showing growth during follow-up with CT scanning. Chest 143:436–443

    Article  PubMed  Google Scholar 

  11. Hiramatsu M, Inagaki T, Inagaki T et al (2008) Pulmonary ground-glass opacity (GGO) lesions–large size and a history of lung cancer are risk factors for growth. J Thorac Oncol 3:1245–1250

    Article  PubMed  Google Scholar 

  12. Callister M, Baldwin D, Akram A et al (2015) British Thoracic Society guidelines for the investigation and management of pulmonary nodules. Thorax 70:ii1–ii54

    Article  PubMed  Google Scholar 

  13. Firth D (1993) Bias reduction of maximum likelihood estimates. Biometrika 80:27–38

    Article  Google Scholar 

  14. Durrleman S, Simon R (1989) Flexible regression models with cubic splines. Stat Med 8:551–561

    Article  CAS  PubMed  Google Scholar 

  15. Govindarajulu US, Spiegelman D, Thurston SW, Ganguli B, Eisen EA (2007) Comparing smoothing techniques in Cox models for exposure–response relationships. Stat Med 26:3735–3752

    Article  PubMed  Google Scholar 

  16. Koehler EM, Sanna D, Hansen BE et al (2014) Serum liver enzymes are associated with all‐cause mortality in an elderly population. Liver Int 34:296–304

    Article  CAS  PubMed  Google Scholar 

  17. Nakata M, Sawada S, Saeki H et al (2003) Prospective study of thoracoscopic limited resection for ground-glass opacity selected by computed tomography. Ann Thorac Surg 75:1601–1605

    Article  PubMed  Google Scholar 

  18. Sakurai H, Dobashi Y, Mizutani E et al (2004) Bronchioloalveolar carcinoma of the lung 3 centimeters or less in diameter: a prognostic assessment. Ann Thorac Surg 78:1728–1733

    Article  PubMed  Google Scholar 

  19. Okada M, Nishio W, Sakamoto T et al (2004) Correlation between computed tomographic findings, bronchioloalveolar carcinoma component, and biologic behavior of small-sized lung adenocarcinomas. J Thorac Cardiovasc Surg 127:857–861

    Article  PubMed  Google Scholar 

  20. Rami-Porta R, Ball D, Crowley J et al (2007) The IASLC Lung Cancer Staging Project: proposals for the revision of the T descriptors in the forthcoming (seventh) edition of the TNM classification for lung cancer. J Thorac Oncol 2:593–602

    Article  PubMed  Google Scholar 

  21. Hwang EJ, Park CM, Ryu Y et al (2015) Pulmonary adenocarcinomas appearing as part-solid ground-glass nodules: Is measuring solid component size a better prognostic indicator? Eur Radiol 25:558–567

    Article  PubMed  Google Scholar 

  22. Song YS, Park CM, Park SJ, Lee SM, Jeon YK, Goo JM (2014) Volume and mass doubling times of persistent pulmonary subsolid nodules detected in patients without known malignancy. Radiology 273:276–284

    Article  PubMed  Google Scholar 

  23. Lee JH, Park CM, Lee SM, Kim H, McAdams HP, Goo JM (2015) Persistent pulmonary subsolid nodules with solid portions of 5 mm or smaller: their natural course and predictors of interval growth. Eur Radiol [Epub ahead of print]

  24. Goldstraw P, Chansky K, Crowley J et al (2016) The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer. J Thorac Oncol 11:39–51

    Article  PubMed  Google Scholar 

Download references

Acknowledgement

The scientific guarantor of this publication is Prof. Dr. Chang Min Park. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study has received funding from the Research of the Korean Foundation for Cancer Research (grant number: CB-2011-02-01).

We appreciate statistical consultation by the Medical Research Collaborating Center at Seoul National University College of Medicine/Seoul National University Hospital.

Institutional Review Board approval was obtained. Requirement of written informed consent was waived by the Institutional Review Board.

Some study subjects or cohorts have been previously reported in [21, 22].

Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

Author information

Authors and Affiliations

  1. Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea

    Jong Hyuk Lee, Chang Min Park, Hyungjin Kim, Eui Jin Hwang, Juil Park & Jin Mo Goo

  2. Cancer Research Institute, Seoul National University, Seoul, Korea

    Chang Min Park & Jin Mo Goo

  3. Aerospace Medical Group, Air Force Education and Training Command, Jinju, Korea

    Hyungjin Kim

  4. Armed Forces Seoul Hospital, Seoul, Korea

    Eui Jin Hwang

Authors
  1. Jong Hyuk Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chang Min Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hyungjin Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eui Jin Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Juil Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jin Mo Goo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chang Min Park.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, J.H., Park, C.M., Kim, H. et al. Persistent part-solid nodules with solid part of 5 mm or smaller: Can the ‘follow-up and surgical resection after interval growth’ policy have a negative effect on patient prognosis?. Eur Radiol 27, 195–202 (2017). https://doi.org/10.1007/s00330-016-4364-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-016-4364-9

Keywords

Search

Navigation